alexa Acute lymphocytic leukemia | Ireland | PDF | PPT| Case Reports | Symptoms | Treatment

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Acute Lymphocytic Leukemia

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  • Acute lymphocytic leukemia

     Acute lymphoblastic leukemia, also known as acute lymphocytic leukemia or acute lymphoid leukemia (ALL), is an acute form ofleukemia, or cancer of the white blood cells, characterized by the overproduction and accumulation of cancerous, immature white blood cells, known as lymphoblasts.

    ALL, lymphoblasts are overproduced in the bone marrow and continuously multiply, causing damage and death by inhibiting the production of normal cells (such as red and white blood cells and platelets) in the bone marrow and by spreading (infiltrating) to other organs. ALL is most common in childhood, with a peak incidence at 2–5 years of age and another peak in old age.

    The signs and symptoms of ALL are

    • Generalized weakness and fatigue

    • Bone pain, joint pain (caused by the spread of "blast" cells to the surface of the bone or into the joint from the marrow cavity)

    • Breathlessness

    • Enlarged lymph nodes, liver and/or spleen

    • Pitting edema (swelling) in the lower limbs and/or abdomen

    • Petechiae, which are tiny red spots or lines in the skin due to low platelet levels

    Tests and Diagnosis

    • Physical examination

    • Complete blood count

    • Blood smear

    • Bone marrow biopsy

    • Spinal tap

  • Acute lymphocytic leukemia

     Treatment and Medication

    Chemotherapy

    Remission induction: Combination of prednisolone or dexamethasone, vincristine, asparaginase (better tolerance in pediatric patients), and daunorubicin (used in Adult ALL) is used to induce remission. Central nervous system prophylaxis can be achieved via irradiation, cytarabine and methotrexate, or liposomal cytarabine.In Philadelphia chromosome-positive ALL, the intensity of initial induction treatment may be less than has been traditionally given.

    Consolidation: Typical consolidiation protocols use vincristine, cyclophosphamide, cytarabine, daunorubicin, etoposide, thioguanine or mercaptopurine given as blocks in different combinations. For CNS protection, intrathecal methotrexate or cytarabine is usually used combined with or without cranio-spinal irradiation (the use of radiation therapy to the head and spine). Central nervous system relapse is treated with intrathecal administration of hydrocortisone, methotrexate, and cytarabine.

    Maintenance therapy: Oral mercaptopurine, once weekly oral methotrexate, once monthly 5-day course of intravenous vincristine and oral corticosteroids are usually used. The length of maintenance therapy is 3 years for boys, 2 years for girls and adults. And the other include Immunotherapy: Chimeric antigen receptors (CARs) have been developed as a promising therapy for ALL. This technology uses a single chain variable fragment (scFv) designed to recognize the cell surface marker CD19 as a method of treating ALL. CD19 is a molecule found on all B-cells and can be used as a means of distinguishing the potentially malignant B-cell population in the patient.

    Biological therapy: ALL, aiming at biological targets such as the proteasome, in combination with chemotherapy, has given promising results in clinical trials.Selection of biological targets on the basis of their combinatorial effects on the leukemic lymphoblasts can lead to clinical trials for improvement in the effects of all treatments.

    Radiation therapy: Radiation therapy (or radiotherapy) is used on painful bony areas, in high disease burdens, or as part of the preparations for a bone marrow transplant.

  • Acute lymphocytic leukemia

     Statistics

    Leukaemias made up about 1.7% of all registered cancers and 2.0% of malignant cancers diagnosed between 1994 and 2008. Between 1994 and 2002 the number of cases increased annually by 4.5% for men and 3.4% for women; however since 2002 there has been no increase in numbers for women, and a downward trend of 3% a year for men. The agestandardised incidence rate has been falling by 6% annually for both sexes since 2000.Survival was best for CLL (90% at 1 year and 70% at five years from diagnosis) and poorest for AML. For the acute leukaemias, especially AML, most of the mortality occurred in the first year after diagnosis.

    There was a modest improvement over time in three-year survival for all leukaemias combined, from 60% (58%-62%)1 in 1994-1997 to 63% (61%-65%) in 2002-2005. The main improvement was for ALL, from 66% (59%-73%) in 1994-1999 to 76% (71%-81%) in 2004-2006. The EUROCARE data, although now quite dated, shows that survival from leukaemia for patients diagnosed in Ireland in 1995-1999 was relatively good. Between 1950 and 1970 there was a rapid increase in leukaemia mortality, greater in males than females. Some of this increase may have been due to better diagnosis. Death rates have declined slightly since then, and to a greater extent in females than males.

    Death rates for children (under 15) were as high as for adults in the 1950s, but fell steeply until the early 1990’s, due to major advances in chemotherapy. Death rates in children have remained fairly constant since 1990.

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